Molars are the largest teeth. Their sizable chewing surface makes them ideal for crushing and grinding food, which is their primary function. The permanent teeth include 12 molars located in groups of 3 at the back of the mouth. The third molars, or wisdom teeth, are the rearmost teeth and typically the last to come in. The upper molars lie in close proximity to the maxillary sinuses in the cheekbones. The lower molars reside near major blood vessels and nerves. A molar toothache can originate from a dental condition affecting the tooth, gums or surrounding bone, or from certain medical conditions.
Dental decay, or a cavity, that penetrates near or into the dental pulp within a tooth is one of the most common causes of molar tooth pain. Inflammation of the dental pulp, which includes nerve tissue, can lead to an infection with pain and swelling. The first molars are particularly vulnerable because they typically come in by age 6 to 7, making them susceptible to cavities at a young age. A loose filling or crown is another possible cause of molar tooth pain. Similarly, a crack in a tooth can cause pulp inflammation and tooth pain. Since molars function in chewing, they frequently develop cracks. Other dental problems that can provoke a molar toothache include:
-- abscessed tooth
-- infection of the gums, or periodontal disease
-- loosening or inflammation of the ligaments that hold the teeth in place
Maxillary sinusitis or a sinus infection can cause pain in the upper molars because their roots lie close to or within the sinus cavity. Pain from the jaw joints or muscles -- temporomandibular joint (TMJ) dysfunction -- is another consideration in people experiencing a molar toothache without an identifiable dental cause. Clenching or grinding the teeth and misalignment of the teeth can predispose a person to TMJ pain. Injury, compression or malfunction of nerves that supply sensation to the teeth can also lead to tooth pain. Some people with migraines also experience tooth pain during attacks. Other medical conditions that can potentially cause molar tooth pain include:
-- angina, or heart-related pain due to insufficient blood delivery
-- jaw or mouth tumors
-- blood vessel malformations near the teeth
Relief from molar toothache pain depends on an accurate diagnosis and appropriate treatment. A visit to your dentist is typically the first step and usually involves dental x-rays and an examination of the painful area. Diagnostic tests include placing ice and possibly heat on the painful molar to determine the condition of the dental pulp. An abscessed tooth is commonly tender to tapping with a metal dental instrument. Probing along the outside of the tooth is important to determine the health of the attachment of the gum to the tooth and bone. If no dental cause can be identified, referral to a medical doctor is necessary to diagnose the cause of molar pain.
Treatment for molar tooth pain depends on the cause. Removal of the dental pulp is necessary for treatment of an infected or abscessed tooth. This can be successfully accomplished with root canal treatment in most cases. Tooth extraction is another option to remove the diseased dental pulp. Pain from a gum infection is usually resolved with periodontal cleaning of the pocket adjacent to the tooth. Severe cases of periodontal disease may require oral surgery. A cracked tooth can potentially be treated with a tooth band or crown. Pain medications and antibiotics may be prescribed for severe pain and swelling from an abscessed tooth or periodontal abscess.
Treatment for nondental causes of molar pain involve management of the underlying medical disorder. For example, sinusitis-related tooth pain is often treated with antibiotics, decongestants and salt water rinses. Prescription medications can generally help relieve tooth pain due to nerve or heart disorders.
Warnings and Precautions
Regular dental checkups and daily oral hygiene help prevent most dental causes of molar toothaches. Consult your dentist at the first sign molar pain. Such discomfort often comes and goes initially. Waiting until you have constant tooth pain might make it more difficult to save the involved tooth. Unfortunately, root canal and periodontal treatment cannot save all diseased molar teeth. Tooth extraction might be the only option for molar problems involving extensive decay, bone loss or deep fractures.
Seek urgent medical or dental care if you experience a molar toothache accompanied by a fever, or facial redness or swelling. These symptoms might signal a soft tissue or bone infection, both of which require immediate treatment.
Reviewed and revised by: Tina M. St. John, M.D.